Evaluations. Learn the Signs. Act Early. The Importance of Developmental Screening. Conflict of Interest Statement.

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1 Learn the Signs. Act Early. The Importance of Developmental Screening. April 19, 2012 Featured Speakers Judith Lucas, MD Pediatrician, Behavioral Health Albany Medical Center Donna M. Noyes, PhD Associate Director for Clinical Policy New York State Department of Health Bureau of Early Intervention Conflict of Interest Statement The speakers and their viewpoints represent no conflicts of interest. Evaluations Send a Question for the Presenters to: Nursing Contact Hours, CME and CHES credits are available. Please visit to fill out your evaluation and complete the post test. phlive.ny@gmail.com Thank you! 1

2 Thank You to Our Sponsors: Centers for Disease Control and Prevention s National Center on Birth Defects & Developmental Disabilities Association for Maternal and Child Health Programs University at Albany School of Public Health New York State Department of Health, Bureau of Early Intervention Learn the Signs. Act Early Importance of Developmental Screening Judith Lucas, MD Developmental Pediatrician Albany Medical Center Learning Objectives Review important developmental milestones in early childhood Discuss the importance of developmental screening at well child visits Highlight national recommendations for screening, including standardized tests Provide information about steps to take if a concern is identified Developmental Milestones Some signs of development are obvious: Height, weight, head size Crawling, walking Fine motor skills Talking Others are not as obvious. By 15 months, most toddlers: Make eye contact when spoken to Reach to anticipate being picked up Show shared attention in object/activity Display social imitation, such as return a smile Respond consistently to spoken name Respond to simple spoken request Say mama or dada By 18 months, most toddlers: Point to body parts Speak some words Pretend play, like feeding a doll Point out objects Respond when a person points Act early if: Doesn t point to show things to others Doesn t copy others Doesn t gain new words Doesn t notice when a caregiver leaves or returns 2

3 By 24 months, most toddlers: Use two word phrases Show interest in other children Imitate adults or other kids Point to things or pictures when they are named Act early if: Doesn t use two word phrases Doesn t know what to do with common things Doesn t copy actions and words What is Autism? Autism Spectrum Disorder (ASD) Autistic Disorder Pervasive Developmental Disorder Not Otherwise Specified (PDD NOS) Asperger s syndrome DSM IV Diagnostic Criteria: Autism DSM IV Criteria: Autism 1. Qualitative Impairment in Social Interaction A. Marked impairment in nonverbal behaviors, such as eye contact, facial expression, body postures, gestures B. Failure to develop peer relationships appropriate to developmental level C. Lack of spontaneous seeking to share enjoyment, interests, achievement D. Lack of social or emotional reciprocity 2. Qualitative Impairments in Communication A. Delay in or total lack of the development of spoken language (not accompanied by attempt to use alternative modes of communication) B. In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others C. Stereotyped and repetitive use of language or idiosyncratic language D. Lack of make believe or social imitative play appropriate to developmental level DSM IV Criteria: Autism To Diagnose an ASD: 3. Restricted, repetitive and stereotyped patterns of behavior, interests and activities A. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus B. Apparently inflexible adherence to specific nonfunctional routines and rituals C. Stereotyped and repetitive motor mannerisms D. Persistent preoccupation with the parts of objects A total of six (or more) items from (1), (2) and (3) with at least two from (1) and one each from (2) and (3) = AUTISTIC DISORDER (AD) At least two from (1) and at least one from (3) with a significant functional impairment = ASPERGER S SYNDROME (AS) Significant social or behavioral impairment and above criteria are not met, onset after 3 years, atypical or sub threshold symptomatology = PDD NOS 3

4 Prevalence of Autism American Academy of Pediatrics 1 in 88 children by age 8 Almost 5 times more likely in boys 23% increase since 2009, 78% increase since 2007 Changes in diagnosis, increased awareness Standardized screening tools, effective intervention Other reasons? Most children not diagnosed until 4 years old, even though early intervention can help a child Recommendation: Surveillance at every well child visit Screen with standardized tool if concerned Developmental Screening at 9, 18, & months Autism specific Screening at 18 & months Developmental Surveillance Developmental Screening Tools: Listen Look Think about risk Talk to parents about their concerns Most parents will tell you early on if there is a concern. Record, monitor, refer At 9, 18, and month well child visits: Extensive list available in the journal Pediatrics* Ages and Stages Questionnaire Parents Evaluation of Developmental Status CPT code Cost associated with these tests *Identifying Infants and Young Children with Developmental Disorders in the Medical Home. Pediatrics. 2006; 118: Autism Screening Tools: Red Flags At 18 & month well child visits Modified Checklist of Autism in Toddlers (MCHAT) with follow up interview Infant Toddler Checklist (ITC) CPT code Free to download, print and score MCHAT: www2.gsu.edu/~psydlr/dianalrobins/official_m CHAT_Website.html ITC: Delay or absence of speaking words Loss of words that were spoken Lack of nonverbal communication Looks through people or not aware of people Lack of taking turns or imitation Does not point to an object to tell another person to look at it Limited or no joint attention Unusual or repetitive hand and finger gestures 4

5 Physicians: If You are Concerned: Schedule a follow up visit to discuss concern, develop a plan Refer for an evaluation (developmental pediatrician, psychologist, or neurologist) Refer to Early Intervention or local school Parents: If You are Concerned: Parents: Schedule a doctor s visit to discuss concerns Contact Early Intervention Program, if under 3 Toll Free , or 311 in NYC Physician referral is not required Contact local school district, if 3 or older Reach out to other parents, advocacy groups Parent to Parent of NYS Early Childhood Direction Centers Wait and See? Parent concerned at 18 months Physician says wait and see, boys develop language later Parent calls early intervention at 28 months, receives speech therapy two times/week Child begins preschool, does poorly Diagnosis at 4 years old, intensive behavioral intervention begins If you are concerned, act early! Early Intervention NYS Efforts to Promote Early Developmental and Autism Screening Donna M. Noyes, Ph.D. Bureau of Early Intervention New York State Department of Health Federal Individuals with Disabilities Education Act (IDEA), Part C Serve 70,000 infants and toddlers birth to 3 5,000 with an autism spectrum disorder Therapeutic and Support Services No Cost to families 5

6 Federal & Private Grants Health Resources and Services Administration: State Implementation Grant to Improve Services for Children with ASD & their families ( ) Maternal & Child Health Autism Research Grant ( ) FAR Fund Grants: Physician Training & Support (2012) Update Clinical Practice Guidelines ( ) Goals of HRSA State Implementation Grant 1. Promote AAP guidelines for developmental and ASD screening of young children at well child visits 2. Engage and support pediatricians and family physicians to screen and refer children & stay involved 3. Increase awareness among parents and early childhood professionals about the importance of screening & NYS and national resources Physician Training & Support Two part evening training sessions with CME credits Part 1: Early Identification & Screening Incorporating universal screening for ASDs and other developmental concerns into MDs practices Developmental surveillance and screening Early signs of ASDs Resources & introduction to physician portal Physician Training & Support Two part evening training sessions with CME credits Part 2: Early Intervention & Ongoing Medical Management Evidence based Interventions Medical Management and Complimentary Alternative Medicine (CAM) Communicating with Parents Online Resource Portal for Physicians on Autism Spectrum Disorders Developed an on line ASD portal for NYS physicians hosted on the DOH Health Commerce System Offer access to information on ASDs to assist physicians Collaborate with University Centers for Excellence on Developmental Disabilities and Hunter College to serve as on line faculty for physicians 6

7 Other Training Approaches Abbreviated training sessions during statewide physicians meetings Grand rounds in hospitals NYC training with Hunter College and Weill Cornell Medical College NYS Early Intervention Program /early_intervention Growing Up Healthy Hotline: , in NYC call 311 7

8 Additional NYS Resources Free Milestone Checklist healthytransitionsny.org CDC Materials Brochures Posters Booklets Free Order online More Information Local Early Intervention Contacts: , TTY In NYC, early_intervention/county_eip.htm NYS Early Intervention Program: bei@health.state.ny.us Evaluations Nursing Contact Hours, CME and CHES credits are available. Please visit to fill out your evaluation and complete the post test. Thank you! 8